Gynaecological Oncology, Somerset NHS Foundation Trust, Taunton, TA1 5DA, United Kingdom.
Gynaecological Oncology, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, United Kingdom.
Int J Gynecol Cancer. 2020 Aug;30(8):1177-1182. doi: 10.1136/ijgc-2020-001263. Epub 2020 May 5.
Recurrence of low-risk endometrioid endometrial cancer is rare, and traditional hospital follow-up has a cost to both the patient and the healthcare system, without evidence of benefit. We examined the uptake of patient-initiated follow-up, pattern of recurrences, and survival for women following surgical treatment of low-risk endometrial cancer and compared estimated costs with hospital follow-up.
This study was a prospective audit of outcomes following implementation of a patient-initiated follow-up policy in a UK-based gynecological cancer center for women with low-risk endometrial cancer treated surgically (International Federation of Gynecology and Obstetrics (FIGO) stage 1A, G1-2) from January 2010 to December 2015. Women were identified following multidisciplinary team meetings and data were collected from the electronic cancer register, paper, and electronic clinical records. Health service costs were calculated based on standard tariffs for follow-up appointments; patient costs were estimated from mileage traveled from home postcode and parking charges. Progression-free survival and overall survival were assessed. Estimated financial costs to the health service and patients of hospital follow-up were compared with actual patient-initiated follow-up costs.
A total of 129 women were offered patient-initiated follow-up (declined by four; accepted by another 11 after hospital follow-up for 6 months to 3.5 years) with median follow-up of 60.7 months (range 1.4-109.1 months). Ten women recurred: four vaginal vault recurrences (all salvaged), three pelvic recurrences (all salvaged), and three distant metastatic disease (all died). Five-year disease-specific survival was 97.3%. Ten women in the cohort died: three from endometrial cancer and seven from unrelated causes. The cost saving to the health service of patient-initiated follow-up compared with a traditional hospital follow-up regimen was £116 403 (median £988.60 per patient,range £0-£1071). Patients saved an estimated £7122 in transport and parking costs (median £57.22 per patient,range £4.98-£147.70).
Patient-initiated follow-up for low risk endometrial cancer has cost benefits to both health service and patients. Those with pelvic or vault recurrence had salvageable disease, despite patient-initiated follow-up.
低危型子宫内膜癌的复发较为罕见，传统的医院随访既增加了患者的负担，也耗费了医疗系统的资源，但并无获益证据。我们调查了接受手术治疗的低危型子宫内膜癌患者采用患者主导的随访模式的接受程度、复发模式和生存情况，并将估计的成本与医院随访进行了比较。
这是一项在英国妇科癌症中心开展的前瞻性研究，对 2010 年 1 月至 2015 年 12 月期间接受手术治疗（国际妇产科联合会分期 1A 期、G1-2 级）的低危型子宫内膜癌患者实施患者主导的随访政策后的结局进行了回顾性分析。通过多学科团队会议确定患者，并从电子癌症登记系统、纸质病历和电子临床记录中收集数据。根据随访预约的标准费用计算卫生服务成本；根据患者家庭邮编和停车收费计算患者成本。评估无进展生存率和总生存率。比较医院随访的实际患者主导随访成本与卫生服务和患者的估计财务成本。
共有 129 名患者被提供了患者主导的随访（4 名患者拒绝，4 名患者在接受医院随访 6 个月至 3.5 年后选择接受），中位随访时间为 60.7 个月（范围 1.4-109.1 个月）。10 名患者复发：4 名阴道穹窿复发（均经挽救治疗），3 名盆腔复发（均经挽救治疗），3 名远处转移（均死亡）。5 年疾病特异性生存率为 97.3%。队列中有 10 名患者死亡：3 例死于子宫内膜癌，7 例死于其他原因。与传统的医院随访方案相比，患者主导的随访为卫生服务节省了 116403 英镑（每名患者的中位数节省费用为 988.60 英镑，范围 0-1071 英镑）。患者在交通和停车方面节省了约 7122 英镑（每名患者的中位数节省费用为 57.22 英镑，范围 4.98-147.70 英镑）。
患者主导的低危型子宫内膜癌随访对卫生服务和患者均具有成本效益。尽管采用了患者主导的随访，但那些有盆腔或穹窿复发的患者仍有可挽救的疾病。
